James L Carey

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

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Publications (60)162.47 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: While the characteristics of osteochondritis dissecans (OCD) of the knee that require surgery to heal have been described, several surgical techniques/procedures exist with no consensus established regarding timing of treatment and specific surgical intervention. In this study, we aim to determine current trends in surgical treatment for OCD lesions in the skeletally immature who have failed 6 months of nonoperative management by surveying a large cohort of orthopaedic surgeons. Methods: An electronic survey designed using REDCap to capture surgeon treatment preferences for OCD lesions was distributed to members of the Pediatric Orthopaedic Society of North America (POSNA). The survey inquired about treating physicians' training and demographics. It then offered a series of clinical vignettes alongside imaging describing patients with varying degrees of severity of OCD following nonoperative treatment. Surgeons were prompted to select from a variety of multiple-choice-based options for further patient management. Standard descriptive statistics were used to summarize and compare the responses. Results: Of the 129 POSNA members completing the pediatric survey, 97.7% were attending level orthopaedic surgeons, the majority identifying with an academic institution and treating mostly skeletally immature patients. In the skeletally immature population, the majority would treat intact, stable OCD lesions with drilling in a retroarticular or transarticular manner. Preferred treatment for unstable, salvageable lesions was screw fixation using bioabsorble materials or metal with variable pitch with no bone graft. The majority of respondents would treat unstable, unsalvageable OCD lesions with chondroplasty and osteochondral transplant/transfer or microfracture/drilling. Conclusions: The POSNA membership appears to agree on principle in terms of treatment modalities for various stages of OCD lesions in the skeletally immature, whereas individual techniques of achieving these principles may vary. Members endorse drilling for stable intact lesions; fixation for unstable, salvageable lesions; and "defect fill" for unsalvageable lesions. Clinical significance: OCD surgical treatment patterns can be used in future studies to determine which techniques are most effective for given indications, with the goal of designing a research-proven optimal treatment regimen for skeletally immature patients.
    No preview · Article · Dec 2015 · Journal of pediatric orthopedics
  • CG Pfeifer · MB Fisher · JL Carey · RL Mauck
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    ABSTRACT: Promising therapies for cartilage repair are translated through large animal models toward human application. To guide this work, regulatory agencies publish recommendations (“guidance documents”) to direct pivotal large animal studies. These are meant to aid in study design, outline metrics for judging efficacy, and facilitate comparisons between studies. To determine the penetrance of these documents in the field, we synthesized the recommendations of the American Society for Testing and Materials, U.S. Food and Drug Administration, and European Medicines Agency into a scoring system and performed a systematic review of the past 20 years of preclinical cartilage repair studies. Our hypothesis was that the guidance documents would have a significant impact on how large animal cartilage repair studies were performed. A total of 114 publications meeting our inclusion criteria were reviewed for adherence to 24 categories extracted from the guidance documents, including 11 related to study design and description and 13 related to study outcomes. Overall, a weak positive trend was observed over time (P = 0.004, R2 = 0.07, slope = 0.63%/year), with overall adherence (the sum of study descriptors and outcomes) ranging from 32 ± 16% to 58 ± 14% in any individual year. There was no impact of the publication of the guidance documents on adherence (P = 0.264 to 0.50). Given that improved adherence would expedite translation, we discuss the reasons for poor adherence and outline approaches to increase and promote their more widespread adoption.
    No preview · Article · Oct 2015 · Science translational medicine
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    ABSTRACT: Background: Shoulder instability is a common cause of pain and dysfunction in young, active patients. While studies have analyzed risk factors for recurrent instability and failure after instability surgery, few have examined which variables are associated with initial surgery in this patient population. Purpose: To identify variables that may be associated with surgical intervention in patients with shoulder instability in the context of the FEDS (frequency, etiology, direction, severity) classification, a system that may be useful in the surgical treatment of shoulder instability patients. Study design: Cohort study (prognosis); Level of evidence, 2. Methods: A database of patients treated for shoulder instability from 3 separate institutions from 2005 to 2010 was generated using International Classification of Diseases-9th Revision data. Data were collected via retrospective review. Injury data were categorized according to the FEDS system. Data were analyzed for significance, with the primary outcome of surgical intervention. Summary statistics were used to assess which variables were associated with eventual surgery. To test the unadjusted bivariate associations between shoulder surgery and each data point, Pearson chi-square tests were used for categorical variables and Wilcoxon tests were used for continuous variables. Results: Over the study time period, 377 patients were treated for shoulder instability. Patients who had surgery were more likely younger, had recurrent instability, and had their initial injury while playing a sport. Most patients had anterior instability; however, there was a greater proportion of posterior instability patients in the operative group. Severity of dislocation, measured by whether the patient required help to relocate the shoulder, was not significantly associated with eventual surgery. While imaging was not available for all patients, surgical patients were more likely to have magnetic resonance imaging findings of anterior labral injury and less likely to have a supraspinatus or subscapularis tear. Conclusion: Patients who underwent surgery for shoulder instability were younger, more likely to have experienced recurrent instability, and more likely to have sustained their original injury while playing sports. The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment.
    Preview · Article · Oct 2015
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    ABSTRACT: A 13-year-old right-hand-dominant skeletally immature boy presented to the authors' clinic after being blocked during an overhead dodgeball throw and hearing an abrupt "pop" in the shoulder. He had pain in the subdeltoid region that was most prominent during sports-related activity, particularly throwing. The patient had nonoperative management of a lesser tuberosity avulsion fracture 1 year earlier after a similar injury that occurred during a basketball game. He had returned to normal sporting activity 2 months before the most recent injury. Repeat advanced imaging showed an avulsion fracture of the subscapularis tendon, with a significantly retracted 2-cm component as well as a less retracted component, suggesting acute-on-chronic injury. Given this retraction and the symptoms during throwing, the patient was counseled that surgical management would best facilitate an asymptomatic return to sports-related activity. This case showed acute-on-chronic subscapularis tendon insufficiency with avulsion of the lesser tuberosity and significant retraction of the subscapularis tendon without tearing, a rare injury pattern in adolescents. For fixation of the avulsed lesser tuberosity fracture, an open approach technique was used in which SpeedBridge (Arthrex, Naples, Florida) sutures were passed behind the bone fragment. Four anchors were placed medial and lateral to the subscapularis insertion points to create a knotless double-row footprint. Compared with the published literature, this method of subscapularis fixation offered secure anatomic repair in a time-efficient, user-friendly manner. [Orthopedics. 2015; 38(9):e844-e848.].
    Preview · Article · Sep 2015 · Orthopedics
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    Full-text · Conference Paper · Sep 2015
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    ABSTRACT: Objectives: Tarsometatarsal (Lisfranc) joint injuries commonly occur in American professional football competition; however, the career impact of these injuries is unknown. This study aims to define the time to return to competition for professional football players who sustained Lisfranc injuries and to quantify their effect on athletic performance.
    Preview · Article · Aug 2015
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    Full-text · Article · Apr 2015 · The Journal of Bone and Joint Surgery
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    ABSTRACT: Objectives: Anterior shoulder dislocation is a common injury with an estimated incidence of 23.1/100,000 person-years. In anterior dislocation, associated injuries typically involve the anteroinferior glenoid and posterosuperior humeral head. Patients who suffer a shoulder dislocation are at higher risk of developing glenohumeral arthropathy; the risk increases with recurrent dislocations. However, little is known about the initial cartilage damage after a primary shoulder dislocation. T1ρ is a magnetic resonance imaging (MRI) modality that allows quantification of cartilage proteoglycan content and can be used to detect physiologic changes in cartilage without intravenous contrast. Cartilage degeneration is characterized by decreased proteoglycan content, which results in an increased T1ρ relaxation constant. T1ρ MRI can detect differences in knee cartilage between Kellgren-Lawrence grades as well as acetabular cartilage changes in patients with femoroacetabular impingement. The objectives of this prospective study were to determine if T1ρ MRI can detect cartilage damage following primary shoulder dislocation and to assess for patterns in cartilage damage in anterior dislocations.
    Preview · Article · Mar 2015
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    Kevin G Shea · James L Carey
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    ABSTRACT: Management of Anterior Cruciate Ligament Injuries: Evidence-Based Guideline is based on a systematic review of the current scientific and clinical research. This guideline has been endorsed by the National Academy of Sports Medicine, the American Orthopaedic Society for Sports Medicine, the National Athletic Trainers' Association, and the American Academy of Physical Medicine and Rehabilitation. The guideline contains 20 recommendations, including both diagnosis and treatment. In addition, the work group highlighted the need for better research in the treatment of anterior cruciate ligament injuries. Copyright 2015 by the American Academy of Orthopaedic Surgeons.
    Full-text · Article · Mar 2015 · The Journal of the American Academy of Orthopaedic Surgeons
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    James L Carey · Kevin G Shea

    Full-text · Article · Mar 2015 · The Journal of the American Academy of Orthopaedic Surgeons
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    ABSTRACT: Background: Treatment of osteochondritis dissecans (OCD) of the knee is challenging, and evidence for stage-dependent treatment options is lacking. Basic science approaches utilizing animal models have provided insight into the etiology of OCD but have yet to produce a reliable and reproducible large animal model of the disease on which to test new surgical strategies. Purpose/Hypotheses: The purpose of this study was to develop an animal model featuring an OCD-like lesion in terms of size, location, and International Cartilage Repair Society (ICRS) grading. The hypothesis was that surgical creation of an osteochondral defect followed by placement of a barrier between parent bone and progeny fragment would generate a reproducibleOCD-like lesion. Study Design: Controlled laboratory study. Methods: Bilateral osteochondral lesions were created in the medial femoral condyles of 9 Yucatan minipigs. After lesion creation, a biodegradable membrane was interposed between the progeny and parent bone. Five different treatment groups were evaluated at 2 weeks: a control with no membrane (ctrl group; n ¼ 4), a slowly degrading nanofibrous poly(e-caprolactone) membrane (PCL group; n ¼ 4), a fenestrated PCL membrane with 1.5-mm holes covering 25% of surface area (fenPCL group; n ¼ 4), a collagen membrane (Bio-Gide) (CM group; n ¼ 3), and a fenestrated CM (fenCM group; n ¼ 3). Five unperturbed lateral condyles (1 from each treatment group) served as sham controls. After euthanasia on day 14, the lesion was evaluated by gross inspection, fluoroscopy, micro–computed tomography (micro-CT), and histology. To quantify changes between groups, a scoring system based on gross appearance (0-2), fluoroscopy (0-2), and micro-CT (0-6) was established. Micro-CT was used to quantify bone volume per total volume (BV/TV) in a defined region surrounding and inclusive of the defect. Results: The no scaffold group showed healing of the subchondral bone at 2 weeks, with continuity of subchondral bone elements. Conversely, condyles treated with PCL or CM showed substantial remodeling, with loss of bone in both the progeny fragment and surrounding parent bone. When these membranes were fenestrated (fenPCL and fenCM groups), bone loss was less severe. Histological analysis showed no integration in the cartilage layer in any treatment group, while fibrous tissue formed between the parent and progeny fragments. Micro-CT showed significant differences in mean BV/TV between the PCL (27.4% ± 2.3%) and the sham (47.7%± 1.4%) or no scaffold (54.9% ± 15.1%) groups (P < .01 and P < .05, respectively). In addition, a significant difference in bone loss was evident between the PCL and fenPCL groups (mean BV/TV, 46.6% ± 15.2%; P < .05), as well as between the PCL and fenCM (mean BV/TV, 50.9%± 3.5%) and fenPCL groups (P < .01). Grading by 6 blinded reviewers using an OCD scoring system with 3 subcategories showed a significant difference between control and PCL groups. Conclusion: This study successfully developed a large animal model of OCD-like lesions in the knee joint of Yucatan minipigs. The lesions generated matched characteristics of an ICRS grade 3 OCD lesion in humans. These findings set the stage for ongoing model refinement as well as exploration of novel interventional therapies to restore function and bone and cartilage patency in individuals affected by this rare but significant disease. Clinical Relevance: This developed model will serve as a platform on which to further investigate the natural course as well as emerging treatment options for OCD. Keywords: Knee; osteochondritis dissecans; biology of bone; biology of cartilage; tissue engineering
    Full-text · Article · Feb 2015
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    ABSTRACT: Osteochondritis dissecans (OCD) is a vexing condition for patients, parents, and physicians because of the frequent slow healing and nonhealing that leads to prolonged treatment. Several features on plain radiographs have been identified as predictors of healing, but the reliability of their measurement has not been established. To determine the inter- and intrarater reliability of several radiographic features used in the diagnosis, treatment, and prognosis of OCD femoral condyle lesions. Cohort study (Diagnosis); Level of evidence, 3. Pretreatment anteroposterior, lateral, and notch radiographs of 45 knees containing OCD lesions of the medial or lateral femoral condyle were reviewed in blinded fashion by 7 orthopaedic physician raters from different institutions over a secure web portal at 2 time points over a month apart. Classification variables included lesion location, growth plate maturity, parent bone radiodensity, progeny bone fragmentation, progeny bone displacement, progeny bone contour, lesion boundary, and radiodensity of the lesion center and rim. Condylar width and lesion size were measured on all views. Interrater reliability was assessed using free-marginal kappa and intraclass correlations. Intrarater reliability was assessed using the Cohen kappa, linear-weighted kappa, and intraclass correlations based on measurement type. Raters had excellent reliability for differentiating medial and lateral lesions and growth plate maturity and for measuring condylar width and lesion size. In the subset of knees with visible bone in the lesion, the fragmentation, displacement, boundary, central radiodensity, and contour (concave/nonconcave) of the lesion bone were classified with moderate to substantial reliability. The radiodensity of the lesion rim and surrounding epiphyseal bone were classified with poor to fair reliability. Many diagnostic features of femoral condyle OCD lesions can be reliably classified on plain radiographs, supporting their future testing in multifactorial classification systems and multicenter research to develop prognostic algorithms. Other radiographic features should be excluded, however, because of poor reliability. © 2015 The Author(s).
    Full-text · Article · Jan 2015 · The American Journal of Sports Medicine
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    ABSTRACT: Anterior cruciate ligament (ACL) reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. Limited data are available regarding the agreement among orthopaedic surgeons regarding the causes of primary ACL reconstruction failure and accuracy of graft tunnel placement. Experienced knee surgeons have a high level of interobserver reliability in the agreement about the causes of primary ACL reconstruction failure, anatomic graft characteristics, and tunnel placement. Cohort study (diagnosis); Level of evidence, 3. Twenty cases of revision ACL reconstruction were randomly selected from the Multicenter ACL Revision Study (MARS) database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. All 20 cases were reviewed by 10 MARS surgeons not involved with the primary surgery. Each surgeon completed a 2-part questionnaire dealing with each surgeon's training and practice, as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the causes of graft failure. Interrater agreement was determined for each question with the kappa coefficient and the prevalence-adjusted, bias-adjusted kappa (PABAK). The 10 reviewers have been in practice an average of 14 years and have performed at least 25 ACL reconstructions per year, and 9 were fellowship trained in sports medicine. There was wide variability in agreement among knee experts as to the specific causes of ACL graft failure. When participants were specifically asked about technical error as the cause for failure, interobserver agreement was only slight (PABAK = 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK = 0.55) but only slight agreement on whether a femoral tunnel was too anterior (PABAK = 0.24) and fair agreement on whether it was too vertical (PABAK = 0.46). There was poor overall agreement for ideal tibial tunnel placement (PABAK = 0.17). This study suggests that more objective criteria are needed to accurately determine the causes of primary ACL graft failure as well as the ideal femoral and tibial tunnel placement in patients undergoing revision ACL reconstruction. © 2014 The Author(s).
    No preview · Article · Dec 2014 · The American Journal of Sports Medicine
  • Nicole S. Belkin · Brian J. Sennett · James L. Carey
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    ABSTRACT: Reports of transplantation of the meniscus date back to the early 1900s, but transplantation only more recently became a viable treatment option for select patients. Young patients with persistent pain following total or near-total meniscectomy, with absence of other ligamentous or cartilage pathology, are considered good candidates for meniscal transplantation. A commonly used method of determining allograft size is derived from a regression model that uses height, weight, and gender variables. There are a number of well-described surgical techniques for meniscal allograft transplantation described. Our institution’s preferred technique involves utilization of an entirely soft tissue graft with fixation of the posterior horn via transtibial suture, peripherally via a combination of various meniscal suture techniques and devices and the anterior horn via PushLock anchor. Malalignment, ligamentous instability, and/or articular cartilage pathology should be addressed prior to or at the time of MAT. Although challenging to interpret the literature as whole in regard to the success of meniscal allograft transplantation, the overwhelming majority of reports demonstrate success of the procedure in terms of patient reported outcome measures. As a result of this success, meniscal allograft transplantation appears to be becoming increasingly utilized for selected patients with symptomatic lack of a meniscus.
    No preview · Chapter · Nov 2014
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    ABSTRACT: Background: Most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome; however, graft choice for revision may be limited due to previously used grafts. Hypotheses: Autograft use would result in increased sports function, increased activity level, and decreased osteoarthritis symptoms (as measured by validated patient-reported outcome instruments). Autograft use would result in decreased graft failure and reoperation rate 2 years after revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons at 52 sites. Data collected included baseline demographics, surgical technique, pathologic abnormalities, and the results of a series of validated, patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating score). Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Incidences of additional surgery and reoperation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft rerupture, and reoperation rate at 2 years after revision surgery. Results: A total of 1205 patients (697 [58%] males) were enrolled. The median age was 26 years. In 88% of patients, this was their first revision, and 341 patients (28%) were undergoing revision by the surgeon who had performed the previous reconstruction. The median time since last ACL reconstruction was 3.4 years. Revision using an autograft was performed in 583 patients (48%), allograft was used in 590 (49%), and both types were used in 32 (3%). Questionnaire follow-up was obtained for 989 subjects (82%), while telephone follow-up was obtained for 1112 (92%). The IKDC, KOOS, and WOMAC scores (with the exception of the WOMAC stiffness subscale) all significantly improved at 2-year follow-up (P < .001). In contrast, the 2-year Marx activity score demonstrated a significant decrease from the initial score at enrollment (P < .001). Graft choice proved to be a significant predictor of 2-year IKDC scores (P = .017). Specifically, the use of an autograft for revision reconstruction predicted improved score on the IKDC (P = .045; odds ratio [OR] = 1.31; 95% CI, 1.01-1.70). The use of an autograft predicted an improved score on the KOOS sports and recreation subscale (P = .037; OR = 1.33; 95% CI, 1.02-1.73). Use of an autograft also predicted improved scores on the KOOS quality of life subscale (P = .031; OR = 1.33; 95% CI, 1.03-1.73). For the KOOS symptoms and KOOS activities of daily living subscales, graft choice did not predict outcome score. Graft choice was a significant predictor of 2-year Marx activity level scores (P = .012). Graft rerupture was reported in 37 of 1112 patients (3.3%) by their 2-year follow-up: 24 allografts, 12 autografts, and 1 allograft and autograft. Use of an autograft for revision resulted in patients being 2.78 times less likely to sustain a subsequent graft rupture compared with allograft (P = .047; 95% CI, 1.01-7.69). Conclusion: Improved sports function and patient-reported outcome measures are obtained when an autograft is used. Additionally, use of an autograft shows a decreased risk in graft rerupture at 2-year follow-up. No differences were noted in rerupture or patient-reported outcomes between soft tissue and bone-patellar tendon-bone grafts. Surgeon education regarding the findings of this study has the potential to improve the results of revision ACL reconstruction.
    No preview · Article · Oct 2014 · The American Journal of Sports Medicine
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    ABSTRACT: Several aetiological theories have been proposed for the development of osteochondritis dissecans. Cartilage toxicity after fluoroquinolone use has been well documented in vitro. We present a case report of a 10-year-old child who underwent a prolonged 18-month course of ciprofloxacin therapy for chronic urinary tract infections. This patient later developed an osteochondritis dissecans lesion of the medial femoral condyle. We hypothesise that the fluoroquinolone therapy disrupted normal endochondral ossification, resulting in development of osteochondritis dissecans. The aetiology of osteochondritis dissecans is still unclear, and this case describes an association between fluoroquinolone use and osteochondritis dissecans development.
    Full-text · Article · Sep 2014 · Case Reports
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    ABSTRACT: Objectives: Approximately 30-50% of skeletally immature patients with stable osteochondritis dissecans (OCD) lesions of the knee fail to heal with non-operative treatment, and about 30% of patients who undergo surgery fail to heal radiographically. Unfortunately it is nearly impossible to predict which patients will heal with non-surgical or surgical treatment. We identified multiple OCD features on standard radiographs that may help to predict healing rates. In this study, we test the inter- and intra- rater reliability of orthopaedic surgeons from multiple institutions on classifying these specific OCD radiographic features. Methods: Pre-treatment anteroposterior, lateral, and notch radiographs (Figure) of 45 pediatric knees containing OCD lesions of the medial or lateral femoral condyle were reviewed by 7 physician raters at different medical institutions at two time points. Images were viewed over a secure internet portal. Classifications included lesion location (medial/lateral), growth plate maturity (open/closing/closed), visibility of the progeny bone including fragmentation (yes/no), fragment displacement (none/partial/total), boundary (distinct/indistinct), shape (convex/linear/concave), and comparative radiodensity of the center and rim (more/same/less). Condylar width and lesion size were measured on all views. Inter-observer reliability was measured using free-marginal kappa (kf) and intraclass correlations. Intra-observer reliability was measured using Cohen’s kappa (kc), linear-weighted kappa (klw), and intraclass correlations depending on measurement type. Results: Inter- and intra-observer reliability were excellent for classification of lesion location (kf=0.96, kc=0.97, respectively) and skeletal maturity (ICC=0.86, klw=0.84, respectively) and for measuring knee and lesion size on all views (ICC=0.92-0.98, ICC=0.84-0.95, respectively). The visibility, fragmentation, and displacement of the progeny bone were classified with substantial reliability over time (kc=0.67, kc=0.64, klw=0.80, respectively) and moderate reliability between raters (kf=0.45, kf=0.54, ICC=0.52, respectively). The progeny bone boundary demonstrated substantial reliability between raters (kf=0.62) and moderate reliability over time (kc=0.55). Fair to moderate inter- and intra-observer reliability was obtained for classifying the shape (ICC=0.33, klw=0.53, respectively) and comparative radiodensity of parent and progeny bone (ICC=0.11-0.52, klw=0.32-0.57, respectively). Conclusion: Most of the specific OCD radiographic features tested showed good to excellent reliability. Lesion shape and density had only fair to moderate reliability. The results of the current study support the use of OCD radiographic feature classification in multi-center investigations. Each reliable feature may be correlated with healing in future studies and help to predict OCD outcome at the start of treatment.
    Preview · Article · Aug 2014
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    ABSTRACT: BACKGROUND: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied.METHODS: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45° of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems-the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient.RESULTS: Overall, 45° posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass correlation coefficient = 0.55; 95% confidence interval, 0.53 to 0.56). Similarly, the 45° posteroanterior flexion weight-bearing radiographs had higher correlation with arthroscopic findings of chondral disease (Spearman rho = 0.36; 95% confidence interval, 0.32 to 0.39) compared with anteroposterior radiographs (Spearman rho = 0.29; 95% confidence interval, 0.26 to 0.32). With respect to standards for the magnitude of the reliability coefficient and correlation coefficient (Spearman rho), the International Knee Documentation Committee classification demonstrated the best combination of good interobserver reliability and medium correlation with arthroscopic findings.CONCLUSIONS: The overall estimates with the six radiographic classification systems demonstrated moderate (anteroposterior radiographs) to good (45° posteroanterior flexion weight-bearing radiographs) interobserver reliability and medium correlation with arthroscopic findings. The International Knee Documentation Committee classification assessed with use of 45° posteroanterior flexion weight-bearing radiographs had the most favorable combination of reliability and correlation.
    Full-text · Article · Jul 2014 · The Journal of Bone and Joint Surgery
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    ABSTRACT: Hypothesis The purpose of this cross-sectional study is to determine whether the duration of symptoms influences the features seen in patients with atraumatic, full-thickness rotator cuff tears. Our hypothesis is that an increasing duration of symptoms will correlate with more advanced findings of rotator cuff tear severity on magnetic resonance imaging, worse shoulder outcome scores, more pain, decreased range of motion, and less strength. Methods We enrolled 450 patients with full-thickness rotator cuff tears in a prospective cohort study to assess the effectiveness of nonoperative treatment and factors predictive of success. The duration of patient symptoms was divided into 4 groups: 3 months or less, 4 to 6 months, 7 to 12 months, and greater than 12 months. Data collected at patient entry into the study included (1) demographic data, (2) history and physical examination data, (3) radiographic imaging data, and (4) validated patient-reported measures of shoulder status. Statistical analysis included a univariate analysis with the Kruskal-Wallis test and Pearson test to identify statistically significant differences in these features for different durations of symptoms. Results A longer duration of symptoms does not correlate with more severe rotator cuff disease. The duration of symptoms was not related to weakness, limited range of motion, tear size, fatty atrophy, or validated patient-reported outcome measures. Conclusions There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease.
    Full-text · Article · Jul 2014 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
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    ABSTRACT: Background Research has associated adhesive capsulitis with diabetes mellitus but suggests that glucose-mediated injury may begin before diabetes is diagnosed. The period preceding diabetes is often marked by metabolic syndrome. Methods We investigated the relationship between metabolic syndrome components (insulin resistance, hypertension, dyslipidemia, and obesity) and the development of adhesive capsulitis using a case-control study. We retrospectively reviewed 150 consecutive adhesive capsulitis patient charts to determine the prevalence of obesity and of medications used for treating metabolic syndrome elements and compared these with previously reported nationwide values. Results The prevalence of anti-hyperglycemia medications in the adhesive capsulitis cohort was 18.4% (95% confidence interval [CI], 12.9%-25.7%), twice the national rate of diagnosed diabetes of 7.6% (95% CI, 6.7%-8.5%). In the 20- to 39-year-old group, the prevalence of anti-hyperglycemic medications, 26.3% (95% CI, 11.8%-48.8%), was over 10 times the nationwide rate. The overall prevalence of hypertensive medication use in the adhesive capsulitis group, 33.1% (95% CI, 25.9%-41.2%), was notably higher than the nationwide rate, 21.6% (95% CI, 19.8%-23.4%). In the 40- to 64-year-old group, the prevalence of hypertensive medication use, 36.8% (95% CI, 28.6%-46.0%), was notably higher than the nationwide rate of 24.5% (95% CI, 22.2%-27.0%). The prevalence of anti-lipid medications and obesity was similar between the groups. Conclusions The relationship between adhesive capsulitis and metabolic syndrome remains unclear. Our results confirm previous work associating hyperglycemia with adhesive capsulitis. We have also shown a possible association of hypertension, part of metabolic syndrome and a proinflammatory condition, with adhesive capsulitis, which has not been previously described.
    No preview · Article · Jul 2014 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]

Publication Stats

836 Citations
162.47 Total Impact Points

Institutions

  • 2015
    • Cincinnati Children's Hospital Medical Center
      Cincinnati, Ohio, United States
  • 2012-2015
    • William Penn University
      Filadelfia, Pennsylvania, United States
    • The Ohio State University
      Columbus, Ohio, United States
    • University of Kentucky
      • Department of Orthopaedic Surgery and Sports Medicine
      Lexington, Kentucky, United States
  • 2014
    • Hospital of the University of Pennsylvania
      Philadelphia, Pennsylvania, United States
  • 2011-2014
    • University of Pennsylvania
      • Department of Orthopaedic Surgery
      Philadelphia, Pennsylvania, United States
  • 2008-2011
    • Vanderbilt University
      • Department of Orthopaedic Surgery and Rehabilitation
      Нашвилл, Michigan, United States